Chapter 184: Genitourinary Foreign Body Removal

INTRODUCTION

The literature is replete with case reports of genitourinary foreign bodies. A 1932 case report of a pencil inserted into the penis describes genitourinary foreign bodies as “not so infrequent.”¹ It is difficult to estimate the incident given the broad variety of anatomic locations and their frequent presence as ancillary complaints to a greater issue (e.g., an assault or psychiatric emergency). A tremendous variety of genitourinary foreign bodies present to the Emergency Department. Genitourinary foreign body insertion is typically iatrogenic, self-inflicted, or traumatic.^2-9 The location of foreign bodies can be categorized by location (e.g., external, subcutaneous, vaginal, and within the urethra or bladder). Foreign bodies that are easily visualized can often be handled in the Emergency Department. Those that are complicated or can only be appreciated by imaging are typically more suitable for removal in the Operating Room.

Polyembolokoilamania is the self-insertion of foreign bodies into various body orifices. It presents in many different populations with a variety of causes that can be grouped broadly.¹⁰ The causes can be further distributed by patient age. These are usually the result of play, trauma, or abuse in children.¹¹ Iatrogenic foreign body retention has been reported.¹¹ Vaginal foreign bodies are common in prepubescent girls for a cause of vaginal bleeding.¹² Investigate all presentations of idiopathic atraumatic vaginal bleeding in prepubescent girls.¹² Be vigilant for any signs or symptoms of sexual assault. Screen the patient and family as child victims of sexual assault may present with a vaginal foreign body.¹³ Most presentations in adults are self-insertions due to sexual pleasure, intoxication, or psychiatric conditions.^14,15 Other causes include penetrating trauma (e.g., bullet in the bladder), erosion or fistulization from adjacent structures (e.g., migrated intrauterine device), accidental (e.g., forgetting to remove a tampon or retained broken condom fragments), sexual assault, or a retained foreign body secondary to smuggling or storing items (e.g., drugs or money) inside the vagina.^16,17 Women who are victims of sexual assault or who are sex workers may experience vaginal penetration with a foreign body already inside the vagina. This can lead to the object becoming lodged more deeply within the vagina and increase the chance of soft tissue injury.

The presentation of a genitourinary foreign body is often obvious and the patient will openly admit to the issue. The patient may be reluctant to discuss this in triage and may only reveal their concern to the Emergency Physician during the private interview or as an aside at the end of the encounter. Genitourinary foreign bodies must be considered when complaints of dysuria, hematuria, pain (i.e., pelvic, genital, urethral, or lower abdominal), discharge (i.e., penile and vaginal), urinary retention, or urinary tract infection are evaluated as these foreign bodies may present in a delayed fashion or the history may be unreliable. Foreign bodies may present as secondary findings in patients with a presentation of ...